Sunday, February 28, 2010

What am I, a magnet??

I seem to attract 2 cases consistently: diabetic ketoacidotic patients and foreign bodies. Yup, I had one of each this weekend.

The DKA was frustrating. I wasn't as able to stay on top of her fluids as I should have been. Diabetics are generally dehydrated as a rule. This is 1000 times truer for a DKA patient. As my internal medicine specialist mentor told me, "it often takes incredible quantities of fluids to keep up." After 2 days of managing her, I am not happy with where we are. On the bright side, while her numbers aren't improving, her clinical condition seemed to be...maybe. It's really hard to tell. I'm still obsessing about it, and I've been off work for 3+ hours.

My other magnetism...foreign bodies! A nice lady brought in her 3 year old small breed dog. He had a history of a foreign body 1 year previously that our clinic also fixed. She was pretty sure he had something else stuck. After my physical exam, I was 80% sure she was right...A few hours on fluids with no improvement in dehydration, abdominal palpation that caused regurgitation of foul, dark brown liquid, and a palpable something in the middle of his abdomen, and to surgery we went. I removed a rubber stopper of some sort from his mid-intestines. Currently, he's doing well...but we're still in the iffy period of 24-72 hours. I didn't have to cut out any intestines, so that's encouraging. We shall see. I never count on these until they're at least 3 days out.

We were pretty busy on Saturday, not as busy today. I saw 2 heartworm cases -both in bad shape today - one coughing up blood (hemoptysis) and another in post-caval syndrome. Post-caval syndrome is when the heartworm burden has gotten so heavy that worms are backing up into the vena cava and portal vein. It's a bad, bad thing. The only "cure" for that form of heartworm infection is to make a cut in the JUGULAR vein and take a HUGE pair of forceps, stick them down in the jugular, and start pulling out heartworms. I know...crazy, right? I euthanized that dog, as you can imagine. I also euthanized the one coughing up blood. Both were sad because heartworms are SO completely preventable. Ah, human folly. Both dogs enjoyed Hershey's chocolate eased their passing, and my acceptance of it.

I also saw a SIXTY POUND MINIATURE SCHNAUZER. SIXTY POUNDS. The poor dog was in to see me because she couldn't walk. The owner thought her anal glands needed to be stressed. I can only assume he meant EXPRESSED. I had to try and explain to him that his dog should weight twenty pounds at the most, and the reason she couldn't walk and was covered with URINE scald was because of her morbid, morbid obesity. He didn't believe me, refused xrays to confirm her horrible, palpable arthritis, and took her home with pain medications. I almost lost my cool with him. Not solely because of the dogs condition but because he 1) told me he didn't know me and that his vet was GREAT 2) how expensive we were and 3) how educated he was about dogs.

I had to step out back after that last one.


Elizabeth said...

Last week I got to see a 146lb "female" labrador. She swore up and down her other vet never ever suggested her girl was overweight.
She told me she bred labs at one time and none of her labs were "ever" under 100 lbs. She thought my very fit 75lb male looked too thin. She asked me what was wrong with him. I said he has Addison's but NOTHING is wrong with him. She was there because her girls blood sugar was sky high last week and she was getting it rechecked and this vet had suggested her dog loose some weight.. She however didn't see a problem with the weight. Really I should have asked her if she wanted to race the dogs.. Her dog barely waddled across the room and seemed to be gasping for breath as she walked. Very sad...

Mary said...

Triple the recommended weight? I'm impressed you were able to handle this as well as you did. Poor dog.

I've always been happy that the parrots really can't ingest foreign bodies (or at least not like dogs do) because mine are so curious I'd probably be at the vet all the time with them if this were possible.

Luckily for us they have a pretty good idea of what is food (eat) and what is not (destroy), as we are not always the best supervisors!

Spud said...

Would you consider this animal abuse? If i see a pediatric patient presenting in such a bad state with an incorrigible parent to boot, i will be seriously considering child neglect.

The Homeless Parrot said...

Spud: Unlike human medicine, there is no real recourse when an owner has an animal that is nebulously abused. And keeping an animal morbidly obese is probably the definition of nebulous abuse. I've seen 3 year old dogs in full blown DKA b/c of morbid obesity (once had a 55 pound BEAGLE patient)...

There isn't much recourse in that situation.

For some reason, I let that guy get to me- and that is unusual for me.